Objective: Lumbosacral nerve root pulsed radiofrequency (LS-PRF) may induce muscle contraction by stimulating the corresponding nerve twitch. We investigated the association between twitch and imaging findings during LS-PRF and also the analgesic effects. Method: We assessed the positional relation between the needle and the nerve on imaging findings and the association between these findings and the twitch. We evaluated the pain from 2 to 4 hours after LS-PRF for the short-term analgesic effects that were assessed. In subjects receiving LS-PRF for monoradiculopathy, medium-term analgesic effects were evaluated after 2- to 4 weeks. Results: The incidence of twitch was significantly higher when the needle was close to the nerve fiber than close to where the contrast medium diffused into surrounding tissues. No significant difference in the analgesic effect was found from 2 to 4 hours and 2 to 4 weeks after LS-PRF according to twitch. Conclusion: Twitch tends to develop when the needle is close to the nerves during LS-PRF. There is no significant difference in the short or medium-term analgesic effects in association with twitch.
Purpose: Low reactive-level laser irradiation on the stellate ganglion (SGL) is one of the effective treatments for tension-type headaches. The SGL may have a relaxing effect of the cranial and cervical muscles via an improvement of the tissue circulation. The purpose of the present study was to evaluate the change in blood flow and hardness of the trapezius muscle after SGL in tension-type headache patients. Methods: Sixteen tension-type headache patients were enrolled in this study. Trapezius muscle blood flow and hardness measured by near-infrared spectroscopy and a muscle hardness meter, respectively, were compared before and 5 min after SGL. Results: Total Hb significantly decreased after SGL when compared with the baseline (P<0.05). No changes in the tissue oxygenation index or muscle hardness were observed after the SGL. Conclusion: The SGL for tension-type headache patients may improve congestion of trapezius muscle tissue. However, it seemed that there was no relationship between muscle blood flow and muscle stiffness.
Objective: This study aimed to investigate the predictive factors for pain catastrophizing. Patients: Eighteen patients who have had lower back pain for more than 3 months. Methods: Patients rated their pain intensity by using a visual analogue scale and completed the following questionnaires: the pain catastrophizing scale (PCS), short-form McGill pain questionnaire, pain disability assessment scale, hospital anxiety and depression scale (HADS), and sense of coherence (SOC) scale. Multiple regression analyses were used to correlate the results of the questionnaires to PCS. Results: The results showed that HADS and SOC were associated with PCS. Conclusion: Anxiety, depression, and a sense of coherence might predict pain catastrophizing.
To practically evaluate quality-of-life (QOL) impairment in chronic pain patients, we devised a simple evaluation scale based on the visual analogue scale (VAS). We named it the patient's impaired QOL-VAS (PIQ-VAS) and investigated its applicability in clinical practice. In a screening for depression, 58 patients with chronic pain underwent evaluations with the following scales at the same time point: PIQ-VAS, pain VAS, the SF-8 health survey (SF-8), and the Patient Health Questionnaire-2 (PHQ-2). PIQ-VAS had a moderate negative correlation with all SF-8 subscales, and it was especially influenced by the role-emotional as well as bodily pain subscales. Furthermore, PIQ-VAS in the depression-suspected group (PHQ-2 score of 3 or greater) tended to be larger than that in the other group. We therefore conclude that PIQ-VAS reflects multiple aspects of health-related QOL and could be useful for globally evaluating QOL impairment, including the psychological problems in chronic pain patients.
We retrospectively evaluated the efficacy of temporary spinal cord stimulation (temporary SCS) in patients with zoster-associated pain until six months of its onset. Temporary SCS was applied to 32 patients who were on multiple medications, and those with a root block and sympathetic ganglion block were refractory. The analgesic effects were assessed based on scores of the visual analogue scale (VAS) or numerical rating scale (NRS) before and after treatment. In 20 of the 32 (62.5%) cases, an analgesic effect, which is defined as a ≧50% decrease in the VAS or NRS scores, was observed after the treatment. In 14 cases, such an effect was observed one year after the treatment. Temporary SCS is an effective analgesic technique and may prevent transition to postherpetic neuralgia in case with refractory zoster-associated pain until one year of its onset.
The patient is a 70-year-old man who suffered from both back pain and leg pain resulting from failed back surgery syndrome. We performed implantation of the spinal cord stimulation device for him. It was effective for one year, but he did not use it because the effect attenuated afterwards. Abdominal skin slightly cranial from the stimulation device became necrotic 17 years later. We did not search for any allergy to metal, but the stimulation device moved caudally, and a physical irritation by lead was regarded as the cause of necrosis. A periodical medical examination of the skin is necessary other than the movement of the electrode in the epidural space and the painkilling effect after the implantation of the stimulation device.
Intractable hiccups are a relatively uncommon condition characterized by involuntary, spasmodic contractions of the diaphragm that may last for more than 48 hours or even more than 2 months. We reviewed the medical records of 8 patients with intractable hiccup who were introduced to our pain clinic. Phrenic nerve block and baclofen were effective in 6 patients, but ineffective in the other 2. Our cases showed that that the combination of baclofen and phrenic nerve block could significantly improve the quality of life for a patient with intractable hiccups.
Cases involving complication of herpes zoster infection by motor neuropathy are known. Here we report one with arm paralysis despite administration of antiviral drugs in the early phase of infection. The patient was a 69-year-old male. Painful skin lesions appeared at the right C5-C6 region, and he was diagnosed with herpes zoster infection the next day for which he received antiviral drugs. One week after onset, he presented with difficulties in right shoulder elevation and abduction, as well as weakness of the right deltoid and biceps. The patient was diagnosed with C5-C6 radiculopathy derived from herpes zoster infection, and he was administered a combination of intrathecal steroid injections, continuous epidural analgesia, and physiotherapy. The treatment helped ease his pain during rehabilitation, and arm paralysis improved by 21 weeks after onset. Previous reports have suggested that herpes zoster infection complicated by segmental motor paralysis requires one to two years of recovery. Coordinated treatment appears to be the main factor that contributes to early-stage recovery.
We report three cases of abdominal postherpetic neuralgia (PHN) complicated by motor paresis. Case 1: A 76-year-old man with severe pain in his right abdomen owing to herpes zoster (HZ) was admitted to our hospital 28 days after symptoms began. Case 2: A 75-year-old woman with severe pain in her right lower abdomen owing to HZ was admitted to our hospital 29 days after symptoms began. Case 3: A 72-year-old man with severe pain in his right abdomen also owing to HZ was admitted to our hospital 80 days after symptoms began. All three cases were diagnosed as abdominal PHN complicated by motor paresis attributable to bulging in one side flank and thinning of abdominal muscle as revealed by ultrasound imaging. Although a diagnosis of limb paresis is typically easy, abdominal paresis is difficult to detect.
We report the successful management of intractable pain in a pediatric patient with complex regional pain syndrome (CRPS) using peripheral nerve block and rehabilitation combined with psychological and social support. A 13-year-old girl underwent cast immobilization for ligament rupture of the right ankle. She did not visit the hospital for 3 months until removal of the cast. Three months after cast removal, she visited the previous hospital because of intractable pain with swelling and motility disorder. She was diagnosed with CRPS and referred to our hospital given the inability to undergo rehabilitation from the intractable pain. Continuous lumbar epidural block failed as a result of displacement during rehabilitation. We performed ultrasound-guided continuous sciatic nerve block and great saphenous nerve block, which controlled the pain and enabled her to undergo rehabilitation. We also performed psychological and social support with her family and teachers. Our findings suggest that peripheral nerve block may be effective for intractable pediatric CRPS.
We report here a patient with an initial clinical presentation of sensory and motor neuropathy of the upper limb, with no evidence of spine or entrapment disorders. The patient later developed a sensory neuropathy of the lower limb, leading to further testing that revealed a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA). Systemic diseases including EGPA should be considered when making a diagnosis in patients with multiple mononeuropathy.
We present three patients with persistent postoperative pain (PPP); after joint surgery they were treated successfully by ultrasound-guided pulsed radiofrequency (PRF) on the peripheral nerve. Case 1: A 56-year-old female presented with shoulder pain and a decrease in range of motion (ROM) of the shoulder after rotator cuff repair. Although she had previously undergone conventional therapies, her pain has remained for 21 months. We applied PRF to the suprascapular nerve with ultrasound guidance. After the procedure, the restricted ROM improved immediately and the pain reduced gradually. Case 2: A 79-year-old female had been experiencing refractory knee pain after total knee arthroplasty (TKA) for 9 years. We applied PRF to the saphenous nerve with ultrasound guidance. Her pain improved immediately after PRF. Case 3: A 73-year-old female with allodynia after TKA for 5 years. We performed ultrasound-guided PRF to the saphenous nerve. The allodynia improved immediately after PRF, and these effects lasted for 6 months.
We report two cases of persistent postmastectomy pain with immobilization of the affected upper limb, whose clinical courses were different. They suggest that an interdisciplinary pain management for cancer patients, including physiotherapy and cognitive and behavioral therapy, during cancer treatment phase can be effective to improve not only the physical and mental health status, but also a patient's quality of life.
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